Annette DalePerera ADP ConsultancyUK Lead consultant UNODC international drug treatment quality standards and assurance project Covering Quality standards and assurance mechanisms in drug treatment ID: 634569
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Slide1
Improving quality of drug services in the NHS
Annette Dale-Perera
ADP
ConsultancyUK
, Lead consultant: UNODC international drug treatment quality standards and assurance projectSlide2
Covering
Quality standards and assurance mechanisms in drug treatment
Personal reflections on attempts to improve quality in NHS drug services
Learning points on how quality assurance process can help create recovery orientated drug treatment services Slide3
Quality standards and assurance mechanisms in drug treatment
Growing number
of national and international quality standards and assurance mechanisms for drug treatment
International
UNODC/WHO
quality standards for the drug treatment of drug use disorders (2016) and international piloting of quality assurance mechanisms 2017 onwards
European
quality standards for drug treatment
EQUS
(2016 and piloting 2017 onwards)
UK National systems
QuADS
; Healthcare Commission/NTA; Care Quality Commission
; Scotland “Quality Principles’
‘
Commercial’ systems eg
International
Standardisation
Organisation
(ISO)
general quality assurance systems;
health and social care system eg
CARF
(Commission on Accreditation of Rehabilitation Facilities) with
specialisms for
drug in-patient treatment and residential rehabilitationSlide4
Care Quality Commission England
CQC regulate and inspect all health and social care including drug treatment
NICE tells us what evidence-based and cost effective treatment to provideSlide5
International examples of quality assurance
European Union (EU) new quality standards for drug treatment services
EQUS
Interventions
Level
Service
Level
System Level
Structural quality
Setting
Resource
Legal & ethical
Process quality
Implementatio
n
Procedures
Service
co-operation
Outcome quality
Effectiveness
Effectiveness
Treatment
coverage
Benchmark
Cost-benefit
Cost Utilization
Cost effectivenessSlide6
International examples of quality assurance
United Nations/World Health Organisation
System standards
Service standards
Strategic partnership
Core Management
Needs assessment
Core Care
3-5 year System plan
Patients rights & responsibility
Service funding in line with evidence
Intervention
standards
Funders support system quality
improvement
Setting standards
Target group
standardsSlide7
Personal reflections on attempts to improve quality in NHS drug services
NHS services have many strengths: we need them
NHS has good governance and a culture of quality assurance
NHS good at health – help
p
eople build health recovery capital
BUT
Some NHS
organisations
can also be:BureaucraticRisk averseSlow to implementIllness and disease focusedProfessional interest group drivenSlide8
Example 1: using quality assurance to implement evidence-based opioid substitution treatment
Annual audit inc prescribing practice in line with
Orange
G
uidelines
Audits: Prescribing data, case note audit & service user survey
A
udit team of staff from 9 services: audit each other
Specific focus on
Supervised dispensingMean doses of methadone and buprenorphine What regimens: maintenance or community detoxificationResultsMean doses lower than recommended for maintenanceUnclear regimens (lots of ‘slow reduction’)
50% on supervised dispensing
not visible link to ‘stability”Slide9
Example 1: Implementing evidence-based opioid substitution treatment: actions
Discuss AUDIT results In Clinical governance meetings and with clinicians/prescribers
Mean dose
: clinicians said low doses were ‘client driven’. Second audit on lower dose clients - results that half were using opioids ‘on top’ – so slow reduction = poor practice for these service users.
Clinicians trained on
Optimising
OST
(changing medication, increasing dose, supervision, psychosocial interventions)
Regimens
: Clinical lead trained on OST maintenance in line with Guidelines OR community detox in 3 months. Supervised dispensing: Clinical lead training and supervision
to move to ‘take home’ if stable and not using on top.
Key messages
Regular clinical audit and working with clinicians was required to ensure fidelity to evidence-based prescribingSlide10
Example 2: Implementing recovery-oriented drug treatment in NHS services
Phase 1 2010/12
Review & feedback to staff: painful and challenging
New Leadership team: manager & lead clinician of each service
Quarterly KPI & outcome
data
to
review quality &
performance
Annual audit inc Service User Survey Introduction of cognitive mappingNew Service user involvement strategy Restructured services to increase efficiency & reduce unit costs 25%Slide11
Example 2: Phase 2: services
…..following the publication of “Medications in Recovery’ 2012
Review of service model
Re-orientated of staff with a focus on outcomes and helping people gain recovery capital with training in cognitive
mapping
‘experts by experience’ staff & peer volunteers in each service
Assessments revised to include assets
Service user involved in quality governance and service redesign
Service user help redesign recovery
care plans to include “5 ways plans”Service user treatment pathway postersSlide12
Example 2: learning points
1/4ly ‘Leadership
team
’ meetings helped
.
Having TOP outcome data helped (Treatment Outcome Profile)
Psychologists helpful in
modernising
psycho-social interventions championed mutual aid & peer-led servicesEmploying experts by experience (EbyE) with criminal records in NHS took persistence – but then some became Trust starsSome services/staff embraced change more than others. Not so well implemented where staff risk averse or nihilistic. Work with resistance: challenge prejudice against EbyE staffService User Reps monthly meetings with senior management team (over pizza), were helpful to feedback, devise projects and an annual conference.Slide13
Services
became more
vibrant, peer ‘meet & greet’, recovery cafes, mutual aid, social activities, new SU-led care plan format &
allotments
,
and enabled development of a new peer-led charity
Example 2: learning pointsSlide14
Conclusions
NHS has critical role to play in recovery orientated drug treatment
Champion high quality treatment including opioid substitution
It can champion helping service user build health recovery assets
Vaccinate
Hep
B, Treat
Hep
C and HIV
Reduce overdose rates: increase coverage of OST, increase Naloxone distribution, reduce smoking amongst heroin usersRe-orientation has been required in other countries:Asset and deficit focus; service users as partners; helping service user build wider recovery capital, take a long term or extensive approachQuality standards and quality assurance can help this process